Provider Demographics
NPI:1366868481
Name:RAFFERTY, MARLENE E (RD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:E
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:E
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4357
Practice Address - Fax:302-651-4737
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD N005309133V00000X
DEDN0000536133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered